HomeMy WebLinkAboutCLE201600165 Application 2017-01-10Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE rLy
Check # Date:
Receipt # Staff.•
PARCEL INFORMATION 1 (�
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Tax Map and Parcel: 0 1 9AO-00-00-031 00 Existing Zoning �iNPy��n.._ll
Parcel Owner: Catholic Diocese of Richmond
Parcel Address:1205 Pen Park Road City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Ashley Nelson
Address :1205 Pen Park Road City Charlottesville State VA Zip 22901
Office Phone: (434) 964-0400 Cell # 434-610-1767 Fax # 434-964-1373 E-mail a.nelson@cvillecatholic.org
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Charlottesville Catholic School
Previous Business on this siten/a
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
5K race; 250 people from 7am-10am on 10/8/16• parking in school lot & property, approx. 75-100 cars; race begins at
8am; see attached map for details on route
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
1 hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and ac ate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed AsWe_q ` J'eft&01\
APP,96VAL INF ATION
[VApproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official JDate
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on
Date
Mailing a copy of the application to
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
on
Date
to the following address:
[address; written notice mailed to the owner at the last known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of Applicant
Print Applicant Name
Date
01 ► Charlottesville
ifCatholic School
1'('11/ l Knowledge ("OnInI1111rly
June 29, 2016
Rebecca Ragsdale
County of Albemarle
Department of Community Development
401 McIntire Road
Charlottesville, VA 22902
Dear Ms. Ragsdale,
Attached is the Zoning Clearance Application for the Charlottesville Catholic School 15th
Annual All Terrain 5K Run/Walk to be held on Saturday, October 8, 2016. Charlottesville
Catholic School is a 501(c)(3) non-profit educational organization, all contributions to this event
are tax deductible to the fullest extent of the law and any proceeds from the event benefit the
school.
Approximately 250 people of all ages participate in this event which begins and ends at CCS
located at 1205 Pen Park Road. On -site registration is available beginning at 7:00 a.m. and the
run kicks off at 8:00 a.m. On -site registration & water tables will be set-up on the school
property only. The run route begins at the school parking lot, turning right on to the right-of-way
of Pen Park Road and then another immediate right on to park property. A certified flag person
will be stationed where the Charlottesville Catholic School driveway intersects with Pen Park
Road. Runners then proceed to the cart path of Meadowcreek Golf Course. All runners are off
the cart path in less than 30 minutes, or before 8:30 a.m. I have spoken to Rion Summers, the
golf professional at Meadowcreek Golf Course, and received his permission for use of the
course.
From the cart path, runners move on to the Nature Trail that encircles part of the golf course,
emerging onto the park parking lot road, past the tennis courts to Pen Park Road. A certified flag
person will be positioned at the intersection of the parking lot road and Pen Park Road. Runners
will cross Pen Park Road at this intersection and finish the race on the right-of-way of Pen Park
Road back to the Charlottesville Catholic School driveway. The time for runners and walkers to
complete the run circuit ranged from 20 to 54 minutes last year. The post run activities are
finished by 10:00 a.m. Please see the map included in the permit application.
1205 Pen Park Road I Charlottesville, Virginia 22901
434.964.0400 1 (fax) 434.964.1373 1 cvillecatholic.org I info.ccs@cvillecatholic.org
OluO Charlottesville
ifCatholic School
1 (11/h Julwt ledge C,oinvinrnity
The run route is marked with flags and traffic cones are that are provided from VDOT and the
Charlottesville Track Club are placed along Pen Park Road right-of-way. Volunteers are used
extensively and placed along the run route to direct runners, provide water and to clean-up any
articles and garbage left along the event routes. The volunteers are divided into groups by task
assignment. Each group is managed by a volunteer coordinator. All coordinators and volunteers
are given verbal and written instructions. Most of our volunteers have worked the event in past
years and are well seasoned.
I appreciate your prompt review of this application. If I need to provide anything else or you
have questions please contact me at 434-964-0400, ext. 301 or by e-mail at
a.nelson@cvillecatholic.org.
Sincerely,
Ashley Nelson
Co -Race Director
Marketing & Events Coordinator
Charlottesville Catholic School
Phone: 434-964-0400, ext 301
E-mail: a.nelson@cvillecatholic.org
1205 Pen Park Road I Charlottesville, Virginia 22901
434.964.0400 1 (fax) 434.964.1373 1 cvillecatholic.org I info.ccs@cvillecathotic.org
Virginia trnEntDOTf raSporiatipn LAND USE PERMIT
LUP-A
Land Use Permit Application
March 10, 2016
APPLICATION is hereby made for permit as shown on the accompanying plan or sketch and as described below. Said activity(s) will be done under and in accordance with the rules and regulations of the
Commonwealth Transportation Board of Virginia, in so far as said rules are applicable thereto and any agreement between the parties herein before referred to. Where applicable agreements may be
attached and made a part of the permit assembly including any cost responsibilities covering work under permit. Applicant agrees to maintain work in a manner as approved upon its completion. Applicant
also hereby agrees and is bound and held responsible to the owner for any and all damages to any other installations already in place as a result of work covered by resul Ling permit. Applicants to whom
permits are issued shall at all times indemnify and save harmless the Commonwealth Transportation Board members of the Board, the Commonwealth and all Commonwealth employees, agents, and
offices, from responsibility, damage, or liability arising from the exercise of the privileges granted in such permit to the extent allowed by law. In consideration of the issuance of a permit the applicant
agrees to waive for itself, successors in interest or assigns any entitlements it may otherwise have or have hereafter under the Uniform Relocabon and Assistant Act of 1972 as amended in event the
Department or its successor, chooses to exercise its acknowledged right to demand or cause the removal of any or all fixtures, personality of whatever kind or description that may hereafter be located,
should this application be approved.
Type or print clearly
Applicant Driver's license or Tax ID No. 54-1809350
Owner Name Charlottesville Catholic School
Address 1205 Pen Park Road
City Charlottesville State VA Zip Code 22901
Agent Driver's license or Tax ID No. n/a
Agent Name n/a
Address n/a
City n/a State n/a Zip Code n/a
Permit Term Requested n/a
Money Order n/a
Surety Information:
Contact Name
E-mail Address a.nelson@cvillecatholic.org
Telephone Number( 434 ) 964 0400
Emergency Telephone Number ( 434 ) 610
Fax Number( 434 ) 964 1373
Contact Name n/a
E-mail Address n/a
Telephone Number ( n/a )
Emergency Telephone Number ( n/a )
Fax Number( n/a )
Fees Enclosed $ n/a Check Number n/a Coupon Number(s) n/a
Other n/a Estimated cost of work to be performed on VDOT Right of Way $ n/a
Surety Posted by: Owner [
Amount of Surety $ n/a
Surety Company Name n/a
] Agent [ ]
1767
Surety Refund to: Owner [ ] Agent [ ] Surety Waived [ )
Obligation Amount $ non-profit Check # n/a
Bond # n/a
Applicant shall provide proof of registration as an operator with the appropriate notification center in accordance as defined in §2.2-1151.1 of the Code of Virginia & must provide a notarized
affidavit, stating that the utility owner has notified the commercial and residential developer, owner of commercial or multifamily real estate, or local government entities with a property
interest in any parcel of land located adjacent to the property over which the land use is being requested, that application for the permit has been made.
Reouest permission to perform the following activitv(s): Annual 5K Run to be held on Saturday, October 8th, 2016 at 8:00am
Location: [ ] County
Latitude
Between Route No. 631
] Town [ ] City of Albemarle
Longitude
Street Name Rio Road
Route No. 768 Street Name Pen Park Road
Tax Map Number Applicant Job No._
and Route No. Dead End Street Name Dead End
per attached plans.
[ ] IF APPLICABLE, I AGREE TO PAY THE FULL SALARY AND EXPENSES OF A STATE ASSIGNED INSPECTOR IN CONJUNCTION WITH
ACTIVITIES AUTHORIZED UNDER THE AUSPICES OF A VDOT LAND USE PERMIT
Signature of Applicant:
Signature of Agent: _
Title Marketing & Events Coordinator Date 6/28/16
Title Date
All applicable items on this form must be completed to avoid delay in processing the issuance of a VDOT Land Use Permit.
Prepayment required with remittance payable to Virginia Department of Transportation.
VDOT USE ONLY
Receipt is hereby acknowledged for: CHECK No.:
In the Amount of $ for PERMIT FEE $
Authorized VDOT Signature:
MONEY ORDER No.:
CASH SURETY $
Date:
LAND USE PERMIT
LUP-SPG
Special Provisions — General
March 10, 2016
Permittee Agreement for Land Use Permit Issuance
I the undersigned hereby acknowledge that I am fully cognizant of all of the following requirements associated
with the issuance of a VDOT Land Use Permit:
Type or Print clearly
Applicant Name: Charlottesville Catholic School/Ashley Nelson
Applicant Federal Tax ID No. / Driver's License No.: 54 1809350
Applicant / Property Owner Signature:
Agent / Contractor Signature:
Project Name: Charlottesville Catholic School 15th Annual 5K Run
District:
County: Albemarle Route Number:
VDOT Land Use Permit Required by Law
The General Rules and Regulations of the Commonwealth Transportation Board provide that no work of any
nature shall be performed on any real property under the ownership, control, or jurisdiction of VDOT until written
permission has been obtained from VDOT. Written permission is granted for the above -referenced activity
through the issuance of a land use permit.
By issuing a permit, VDOT is giving permission only for whatever rights it has in the right-of-way; the permittee is
responsible for obtaining permission from others who may also have an interest in the property.
The permittee will be civilly liable to the Commonwealth for expenses and damages incurred by VDOT as a result of
violation of any of the rules and regulations of this chapter. Violators shall be guilty of a misdemeanor and, upon
conviction, shall be punished as provided for in §33.2-210 of the Code of Virginia.
Apolication Requirements
Application shall be made for VDOT land use permits through the local district permit office where the activity is to
take place.
Application forms and general information regarding VDOT land use permitting can be obtained by contacting the
central office permit manager or at the following VDOT web site: http://www.virginiadot.org/business/bu-
IandUsePermits.asp
The applicant shall provide a notarized affidavit indicating compliance with the registration and notification
requirements outlined in § 2.2-1151.1 of the Code of Virginia.